Journal of Evolution of Medical and Dental Sciences

Placental Site Subinvolution Leading to Secondary Postpartum Hemorrhage - A Rare Case

Anitha S. — 2026-01-31

G4P1L1A2 with polyhydramnios underwent Elective LSCS. Intraoperatively dense adhesions noted. On pod-8, the patient presented with increased bleeding p/v. On examination, a uterus of 24 weeks’ size, intermittently relaxing. Her coagulation profile was deranged [PT-45.3, APTT-93, INR-4.04]. Portable ultrasound suggested a probability of retained products of conception.

The patient was stabilized with blood and blood products. USG-guided suction and evacuation were attempted, but the procedure was abandoned as the uterine cavity enlarged and no products obtained.

Emergency Subtotal Hysterectomy with B/L internal iliac artery ligation performed. The patient withstood the procedure well. Post-operatively she was managed with blood and blood products. Histopathology report-grossly postpartum uterus measuring 15x15x5 cm without cervix and adnexa. The endometrial cavity appears shaggy brown and the right posterior aspect shows adherent dark brown hemorrhagic tissue measuring 1.5 cm in thickness adherent to the myometrium. Microscopically, the endometrium has large ectatic blood vessels which display scattered trophoblasts within the wall. Many of these vessels show a lack of endothelial lining.

Some of the vessels show fibrin thrombi; chorionic villi are not seen. Consistent with placental site vessel sub involution. There is no evidence of retained products of conception. Risk factors in this patient are previous LSCS with dense adhesions, and inflammation affecting blood vessels. Conservative management like uterine artery embolization can be done where facilities are available.

Placental site subinvolution is a rare form of secondary PPH that has always been underdiagnosed. Incidence of postpartum haemorrhage from subinvolution is most common in the second week postpartum. Diagnosis confirmed by histopathology.

A Rare Case of Duplication Cyst along with Carcinoma Sigmoid Colon Presented as Acute Abdomen - A Case Report

Rahul Jain — 2026-01-31

Gastrointestinal duplications are rare congenital malformations which can occur anywhere in the GIT (Gastrointestinal Tract).^[1] They are bounded by a common wall with or without a connection with the bowel.

The cyst contains one outer muscular layer which is lined with different types of GI mucosa. GIT duplications may present as either solid or cystic tumours, intussusception, perforation, obstruction, or Gl bleeding. Cysts are managed surgically depending on their size, shape and site of adherence.^[2]

Integration of Ultrasonic and Laser-Assisted Techniques in the Surgical Management of Dens Invaginatus - A Case Report

Snehal Babasaheb Shelke — 2026-01-31

Dens invaginatus (DI) is a developmental dental anomaly that predisposes teeth to early pulp necrosis and periapical pathology, often thereby complicating conventional endodontic therapy. This report presents the successful surgical management of a maxillary lateral incisor with Type I DI and chronic apical periodontitis in a 20-year-old patient. Following root canal treatment, periapical surgery was performed incorporating adjunctive techniques, ultrasonic retrograde irrigation using ethylenediaminetetraacetic acid (EDTA) and sodium hypochlorite (NaOCl) gels, and postoperative low-level diode laser therapy to enhance disinfection and healing. At the two-year follow-up, the tooth demonstrated complete clinical and radiographic healing with reformation of the lamina dura and periodontal ligament space. This case underscores the diagnostic value of cone-beam computed tomography (CBCT) and highlights the role of surgical endodontics augmented with adjunctive disinfection and Photobiomodulation in optimizing outcomes for complex cases of dens invaginatus.

Dens invaginatus (DI) is a rare morphogenic aberration caused by an inward folding of the enamel organ into the dental papilla during odontogenesis, occurring prior to hard tissue formation.^[1] The prevalence of DI has been reported to range from 0.3% to 10% and it exhibits a predilection for permanent maxillary lateral incisors.^[2]

Oehler’s classification remains the most widely accepted system, categorizing Dens invaginatus into three types: Type I confined to the crown, Type II extending into the root but not communicating with the periapical tissues, and Type III extending through the root with a separate apical foramen.^[3] The abnormal internal anatomy associated with DI not only predisposes the tooth to early pulp necrosis and periapical pathology but also poses significant therapeutic difficulties.

The complexity of these malformations often compromises conventional root canal treatment, as canal negotiation, biomechanical preparation, and obturation are technically challenging or in some cases impossible.^[4] Various treatment strategies have been proposed, tailored to the type of invagination and the stage of pulp involvement. Preventive measures include prophylactic sealing of the invagination in clinically accessible cases.^[5] Once pulp or periradicular pathology develops, endodontic therapy is indicated, with approaches ranging from conventional nonsurgical treatment and guided endodontics to intentional replantation or endodontic microsurgery.^[6]

When nonsurgical approaches are limited by complex anatomy or fail to achieve healing, surgical endodontic management enables direct visualization and management of the apical area, effective debridement of periapical pathology, and precise retrograde filling.^[7]

This report aims to describe a combined surgical and adjunctive approach for managing Type I dens invaginatus with chronic apical periodontitis, while highlighting diagnostic and therapeutic considerations.

Surgical Technique Video Article: Dissection and Demonstration of Pelvic Sidewall Anatomy as a Key Knowledge Tool for Gynaecologists

Anirban Dasgupta — 2026-02-28

Gynaecology is a vast speciality, with increasing sub specialisation in recent years, including maternal and fetal medicine, reproductive medicine and infertility, gynecological oncology, uro- gynaecology, and minimally invasive benign gynaecology among others.^[1] Endometriosis surgery is another rapidly evolving field, and along with gynaecological oncology, is demanding of extensive knowledge of pelvic anatomy as well as upper abdomen anatomy. Even for benign gynaecology with large broad ligament fibroids, or intractable PPH in Obstetrics, bilateral internal iliac artery ligation bilaterally by pelvic sidewall dissection skills, is mandatory and lifesaving.^[2,3]

This surgical technique article depicts step by step dissection (10 steps) of the pelvic sidewall and anatomy demonstration for safe completion of surgery, whether in uterine/ cervical cancer staging surgery with lymphadenectomy, or parametrial endometriosis or bilateral internal iliac artery ligation during PPH not controlled medically.

Pulmonary Lymphangitis Carcinomatosa Secondary to Breast Carcinoma – A Case Report

Anitha Boregowdanapalya — 2026-02-28

Pulmonary lymphangitis carcinomatosa (PLC) is a distinctive pattern of metastatic spread through the pulmonary lymphatic channels and is commonly associated with breast carcinoma. We present a case highlighting characteristic breast and lung imaging findings emphasizing the radiologist’s role in early diagnosis.

Lymphangitis carcinomatosa accounts for a minority of pulmonary metastases but carries significant prognostic implications.^[1] Breast carcinoma is among the most frequent primary malignancies associated with this condition. Tumour infiltration of pulmonary lymphatic channels leads to characteristic interstitial lung changes, often mimicking pulmonary edema or interstitial lung disease.^[2] The 40-49 years age group is most commonly affected.^[3] In 46% of patients respiratory symptoms are the initial presentation of the underlying carcinoma. The most common underlying primary tumours are breast (33%), stomach (29%) and lung cancers (17%). Approximately 50% die within 3 months of their first respiratory symptoms, but those with a primary prostatic carcinoma may have good remission with adjuvant hormonal therapy.

Clinical, radiographic, and physiological features of drug-induced and radiation-induced pulmonary injury are often difficult to distinguish from other causes of pulmonary infiltrates (e.g., infections, pulmonary edema, alveolar hemorrhage, etc.).^[4] Fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) is essential to exclude infectious etiologies. In some cases, surgical lung biopsies are required to establish a specific etiological diagnosis.

From Blurred Vision into Clarity - Unveiling the Diagnosis of Adolescent Onset Multiple Sclerosis

Mithun J. — 2026-02-28

Adolescent-onset multiple sclerosis is uncommon and often poses diagnostic challenges due to overlap with other pediatric demyelinating disorders.^[1,2] We report a well-documented case of RRMS (Relapsing–Remitting Multiple Sclerosis) in a 15-year-old girl who initially presented with unilateral optic neuritis followed six months later by brainstem–cerebellar symptoms. MRI (Magnetic Resonance Imaging) demonstrated multifocal supratentorial and infratentorialT2/FLAIR hyperintense lesions involving the brain and spinal cord, and CSF (Cerebrospinal Fluid) analysis showed positive oligoclonal bands. The diagnosis of RRMS was established using the 2017 McDonald criteria,^[3] allowing early initiation of DMT (Disease Modifying Therapy) with interferon beta 1a after treatment of the acute relapse with intravenous methylprednisolone. This case highlights the educational value of timely recognition of adolescent-onset MS, application of the revised diagnostic criteria, and the importance of early DMT initiation in a resource conscious setting.

Multiple sclerosis is a chronic immune mediated demyelinating disease of the central nervous system, predominantly affecting young adults.^[1,4]Pediatric-onset MS accounts for approximately 3–5% of all MS cases, with a substantial proportion presenting during adolescence rather than early childhood.^[2,4,5] Compared with adult-onset disease, pediatric and adolescent MS is characterized by higher relapse rates, more inflammatory MRI lesions, and potential long-term cognitive and psychosocial consequences.^[2,6] Early diagnosis is therefore critical. The 2017 revision of the McDonald criteria, including the use of CSF specific oligoclonal bands to demonstrate dissemination in time, has facilitated earlier and more confident diagnosis even after limited clinical events.^[3] We present an educational case of adolescent-onset RRMS illustrating these principles.

Malignant Solitary Fibrous Tumor of the Sinonasal Tract - A Rare Case with Diagnostic Challenges

Naval Kishore — 2026-03-31

Solitary fibrous tumor is a rare mesenchymal neoplasm, most commonly arising from the pleura, with infrequent involvement of the sinonasal tract. Malignant transformation is uncommon and poses significant diagnostic challenges due to overlapping histomorphology with other spindle cell neoplasms. We report a case of malignant solitary fibrous tumor of the sinonasal region in a 52-year-old male who presented with a recurrent nasal mass. Radiologic evaluation revealed an infiltrative lesion arising from the maxillary sinus. Histopathological examination and immunohistochemistry, including STAT6 nuclear positivity, confirmed the diagnosis of malignant SFT. This case highlights the importance of integrating clinical, radiologic, histopathologic, and immunohistochemical findings for accurate diagnosis of this rare entity.

SFT (Solitary Fibrous Tumor) is a mesenchymal neoplasm of fibroblastic origin, classified as an intermediate (rarely metastasizing) tumor in the WHO Classification of Soft Tissue and Bone Tumors (5th edition).^[1] While the pleura is the most common site, extrapleural locations such as the meninges, abdominal cavity, trunk, extremities, and head and neck region have been documented. Sinonasal involvement is particularly rare, accounting for approximately 5% of cases.

Malignant SFTs exhibit aggressive behaviour with potential for local recurrence and distant metastasis. Due to histological overlap with other spindle cell neoplasms of the sinonasal tract, definitive diagnosis requires immunohistochemistry and molecular correlation. We present a rare case of malignant sinonasal SFT with emphasis on diagnostic approach and differential considerations.

Portal Vein Thrombosis in a 67-Year-Old Female Due to Protein C and Protein S Deficiency- A Rare Etiology of Extrahepatic Portal Hypertension

Bilal Ismail — 2026-03-31

Portal vein thrombosis is an uncommon vascular disorder that may lead to portal hypertension and its complications. While cirrhosis and malignancy are the most frequent etiologies, inherited thrombophilias such as protein C and protein S deficiency are rare causes, especially in elderly patients.

PVT (Portal Vein Thrombosis) is a rare but clinically significant condition characterized by partial or complete obstruction of the portal venous system. It can present with nonspecific abdominal symptoms or features of portal hypertension, making early diagnosis challenging. The condition is most commonly associated with liver cirrhosis, hepatobiliary malignancies, and intra-abdominal infections.^[1] However, in a subset of patients without these risk factors, an underlying hypercoagulable state must be considered.

Inherited deficiencies of natural anticoagulants such as protein C and protein S are well-recognized causes of venous thromboembolism, typically manifesting as deep vein thrombosis or pulmonary embolism at a younger age. Their association with isolated portal vein thrombosis in elderly individuals is rare and often underdiagnosed. This case report describes a rare presentation of extensive portal vein thrombosis secondary to protein C and protein S deficiency in a non-cirrhotic elderly patient, emphasizing the need for thorough etiological evaluation.

Maffucci Syndrome - A Rare Presentation of Multiple Enchondromas and Hemangiomas in a 61-Year-Old Male

Sumedha S. Prabhudessai — 2026-03-31

Maffucci syndrome is an exceedingly rare congenital, non-familial mesodermal dysplasia consisting of multiple enchondromas and venous abnormalities like soft tissue hemangiomas or lymphangiomas. The lesions develop slowly and are seen on the phalanges and long bones, which eventually cause growth and developmental malformations. Along with the bone deformities, pathological fractures and loss of mobility are a common occurrence. Maffucci syndrome patients may develop secondary central chondrosarcomas and have a higher risk of developing malignant tumors like gliomas and mesenchymal ovarian tumors. The following case study presents one such case of Maffucci syndrome in a 61-year-old male, in whom it was an accidental finding. Since it is an extremely rare manifestation, the data and treatment modalities are quite limited. There is a need to create a database of Maffucci syndrome and explore its pathophysiology for early diagnosis, treatment and prevention of complications.

Maffucci syndrome is a congenital nonhereditary disease first defined by Carleton et al. (1942). He named it after an Italian pathologist, Angelo Maffuccia, who described the first affected patient in 1881.^[1,2] With less than 300 cases reported worldwide & around 4 cases in India, it becomes an exceedingly rare disorder. The limited economic and scientific resources, along with a lack of awareness among medical professionals could be the cause of under-diagnosis.^[3]

The patients usually present before the onset of puberty with multiple enchondromas, often located within the long bones and multiple hemangiomas primarily in the skin.

The enchondromas are one of the earliest signs of Maffucci syndrome. These cartilaginous tumors cause lytic lesions that distort the affected bones. They cause destruction of the bone matrix and often disproportionate growth, with 40% of patients affected on only one side of the body. It eventually leads to short stature, bowing of the arms and legs, pathological fractures and loss of mobility. An estimated 25-30% of enchondromas develop into chondrosarcomas. There is also an increased risk of malignant transformation of hemangiomas into hemangiosarcomas and hemangio-endotheliomas.^[4,5]

Maffucci syndrome is an extremely rare disease with limited published literature. There are no definite guidelines on the diagnosis, pathogenesis and treatment methods for this disease.^[3] This study aims to contribute to the worldwide database and provide a concise summary regarding the characteristics, etiology, differential diagnosis and possible treatment modalities.